Enteral Feeding

Symptom and description

When weight loss or the inability to eat become severe, nutrition supplements may be needed. These supplements provide water, fiber, fat, protein, vitamins, and other nutrients your body needs for energy. If you are unable to take these supplements by mouth, special tubes can be placed. These tubes allow you to receive the needed nutrients without eating or drinking. The types of special tubes are:

Nasogastric tube. A tube that goes from the nose down the esophagus to the stomach.

Gastrostomy tube. A tube that is placed by the surgeon or gastroenterologist. It's put into the stomach through a small hole outside the stomach wall. The end of the tube sticks out of the skin over the belly. This is also called a PEG tube (percutaneous endoscopic gastrostomy tube).

Jejunostomy tube. A tube that is placed into the upper part of the small intestine (jejunum). The tube is placed by the surgeon through a small hole in the abdomen. The end of the tube sticks out of the skin over the belly.

The type of tube used depends on how long you will need to get tube feedings, your overall health, and your preferences.

Learning needs

You will need to learn to care for your feeding tube tube and learn to give yourself the feedings. You will also need to learn about some of the problems that can happen with tube feedings, how to manage them, and what to report to your healthcare provider. It's a good idea to have a family member or friend with you. They can learn the steps with you and you may find it helps to have someone else know how to deal with the feedings.

Your home health nurse will teach you how to store and prepare the nutritional feedings, how to start and stop the infusions, and what to do if problems happen. It is best to practice the feeding procedure while the nurse is with you. You will also have resources to call in case you have problems or think of additional questions. Always ask questions if you do not understand the information.

Preventing problems

It's important to get the nutrients you need to keep your body as strong and healthy as possible. When care is taken to give the tube feeding safely and correctly, many problems can be avoided. Here are some of the more common problems and what you can do to try to prevent them:

Aspiration

This is when the liquid food that was put in the stomach backs up and is breathed (inhaled) into the lungs.

Suggestions to avoid aspiration:

Sit up to take feeding and for 1 hour after it's done.

If feeding is continuous, keep your head raised on 2 or 3 pillows.

Check for food that's still in your stomach (residual food) before giving a feeding. (Your nurse will teach you how to do this.)

Check placement of the tube before beginning. (Your nurse will teach you how to do this.)

Don't begin a feeding if you feel full or bloated.

Diarrhea

Suggestions to avoid diarrhea:

Don't use feeding solution that has been opened and at room temperature for more than 6 hours.

Don't use feeding solution left open in the refrigerator longer than 24 hours.

Wash your hands before handling the tube or the feeding solution.

Keep the feeding container and tubing or syringes clean.

Constipation

Suggestions to avoid constipation:

Ask about adding fiber to your diet.

Talk with your healthcare provider about using a stool softener or laxative.

Increase your physical activity as allowed.

Skin irritation

Suggestions to avoid skin irritation:

Keep skin around the tube clean and dry.

Check for leakage around the tube and report this to your healthcare provider right away.

Tape the tube securely to prevent pulling.

Change the dressing daily and any time it gets wet.

Apply skin protectant as needed.

Contact your healthcare provider if your nostril with the tube in it or the skin around the tube looks infected (red, painful, or oozing fluid).

Loss of body fluids (dehydration)

Suggestions to avoid dehydration:

Ask your nurse about increasing the amount of water given in the tube between feedings.

Watch for decreased urination or dark-colored urine.

Watch for signs of thirst or fever.

Check with your healthcare provider or about changing the feeding formula.

Tube clogging

Suggestions to avoid tube clogging:

Make sure there are no kinks in the tube.

Flush the tube after feedings.

Flush your tube before and after giving medicines.

Management

Your tube feeding will be given on a schedule that best fits your needs and the amount of calories required. Your healthcare provider, dietitian, or nurse will talk with you about the schedule that is best for you. The choices of schedules are as follows:

Intermittent or bolus. The amount of tube feeding for the day is divided up into smaller portions to be given at set times during the day over short periods. This may be done by gravity (letting the liquid run into the tube on its own) or syringe (using a syringe to gently push in the liquid into the tube).

Continuous tube feeding. The amount of tube feeding for the day is given slowly over a 24-hour period. A pump is used to keep the rate slow and steady.

It is important to make sure the tube is in the right place before starting each feeding. You will be taught how to do this. Make sure you do it every time you use the tube.

Follow-up

If you find your feedings are not working well for you, check with your healthcare provider or dietitian. Talk with them about changing the rate of feeding or the method of feeding.

If the tube becomes dislodged or falls out, put a dressing over the opening and call your healthcare provider right away. Call your healthcare provider right away if your nasogastric tube falls out or changes in length.)

Tell your healthcare provider right away if you have any of the following:

Fever that lasts more than 24 to 48 hours

Fever of 100.4°F (38ºC) or higher, or as directed by your healthcare provider

Diarrhea for more than 1 day

Nausea or vomiting

Constipation

Swelling or bloating in your belly

Tube dislodgement

Tube clogging

Shortness of breath

Coughing

Abnormal sleepiness, disorientation, or confusion

Be sure you know what other problems you should watch for, and know how to get help any time. Know what number to call after office hours, on weekends, and on holidays.